防旋股骨近端髓内针(PFNA)和动力髋螺钉(DHS)治疗股骨转子间骨折的疗效对比分析  

Comparison of the clinical efficacy of two fixation methods for the treatment of intertrochanteric fracture

作　　者：魏良昌 杨荣红[1] 

机构地区：[1]江苏灌云县人民医院,江苏灌云222200

出　　处：《吉林医学》2016年第6期1380-1383,共4页Jilin Medical Journal

摘　　要：目的:比较分析防旋股骨近端髓内针(PFNA)和动力髋螺钉(DHS)两种内固定方法治疗股骨转子间骨折的临床疗效并对其进行分析,为临床选择适当的治疗方法提供一定的借鉴。方法:回顾性分析采用DHS、PFNA治疗股骨转之间骨折患者57例,男35例,女22例,其中右侧28例,左侧29例,年龄35~88岁,平均65.5岁,32例车祸伤,25例为摔伤,EvansⅠa型12例,Ⅰb型11例,Ⅱa型12例,Ⅱb型14例、Ⅲ型8例,全部57例患者中骨质疏松Singh分级3级或3级以下者共29例。结果:57例患者所有患者获得随访,随访时间6~18个月,平均12个月。DHS组手术切口长度12~23 cm,平均15 cm,手术时间60~115 min,平均75 min,术中出血量300~800 ml,平均450 ml,术后引流量100~300 ml,平均220 ml。术后住院时间为7~14 d,平均11.4 d,术后下地时间3 d^3周,平均2周,骨折愈合时间12~42周,平均31周。PFNA组手术切口长度5~15 cm,平均9 cm,手术时间40~120 min,平均62 min,术中出血量200~500 ml,平均300 ml,术后引流量50~200 ml,平均100 ml,术后住院时间为7~14 d,平均11.2 d。术后下地时间1 d^2周,平均4 d,骨折愈合时间12~40周,平均25周,50例患者术后逐渐恢复到术前的行走水平。髋关节功能评分标准(Harris评分)为63~95分,平均88.5分,其中优21例,良27例,中5例,差4例,优良率84.21%。4例患者随访,PFNA组发生1例髋内翻,DHS组发生2例髋内翻,1例螺钉切割股骨头。结论:PFNA在手术切口长度、手术时间、术中出血量、术后引流量、下地负重时间、骨折愈合时间优于DHS。而对EvansI a、Ib股骨转之间骨折,在年龄、住院时间及术后功能评分方面无明显差别。而对于EvansI Ia、IIb、III型股骨转子间骨折和逆转子间型骨折及伴有骨质疏松症老年患者,则宜选用PFNA.Objective The present paper aimed to compare and analyze the clinical efficacy of two fixation methods for the treatment of intertrochanteric fracture,i. e.,the proximal femoral nail antirotation（ PFNA） and the dynamic hip screw（ DHS）,with the purpose of providing certain reference for selecting an appropriate treatment method in the clinical practice. Method A retrospective analysis was carried out on 57 patients（ 35 males and 22 females,aged between 35 and 88 years old,and with an average age of 65. 5 years old） with intertrochanteric fracture and treated by DHS and PFNA methods. The intertrochanteric fracture occurred on the right side in 28 cases and on the left side in 29 cases,and was caused by car accident in 32 cases and by falling in 25cases; the numbers of type EvansⅠa,Ⅰb,Ⅱa,Ⅱb and Ⅲ cases were respectively 12,11,12,14 and 8 cases; among them,29 cases had an osteoporosis Singh grading of grade 3 or below. Results All the 57 patients received follow- up visits with a duration of 6 ～ 18 months and with an average duration of 12 months. In the DHS group,the operative incision length ranged between 12 ～ 23 cm and was 15 cm on average; the operation time ranged between 60 ～ 115 min and was 75 min on average; the bleeding amount during operation ranged between 300 ～ 800 ml and was 450 ml on average; the postoperative drainage ranged between 100 ～ 300 ml and was220 ml on average; the postoperative length of stay ranged between 7 ～ 14 days and was 11. 4 days on average; the postoperative duration of ambulation ranged between three days and three weeks and was two weeks on average; the fracture healing time ranged between 12 ～ 42 weeks and was 31 weeks on average. In the PFNA group,the operative incision length ranged between 5 ～ 15 cm and was 9 cm on average; the operation time ranged between 40 ～ 120 min and was 62 min on average; the bleeding amount during operation ranged between 200 ～ 500 ml and was 300 ml on average; the postoperative drainage ranged between 50 ～

关 键 词：股骨处理间骨折 PFNA DHS 

分 类 号：R687.3[医药卫生—骨科学]